II. Cases in illustration of the Morbid Changes which take place within the Chest; or Thoracic Cases.
Case VII.
Angelica Fidgett.
For symptoms see page 125.
Thorax. Mucous membrane of bronchi, in all their ramifications, exceedingly inflamed; bronchial tubes full of mucus; [substance of left lung extremely inflamed; left pleuræ adherent; right pleuræ and lung much less severely affected.] Head. Substance of brain vascular. Abdomen. All the viscera healthy except the uterus and its appendages, which were slightly inflamed.
Case VIII.
John Potter, æt. 21.
For symptoms see page 127.
Thorax. Mucous membrane of bronchi, in all their ramifications, of dark red colour; bronchial glands much enlarged; [pleuræ of right side generally adherent; substance of lungs consolidated; pericardium contained four ounces of serum;] heart natural. Abdominal and cerebral organs healthy.
Case XIV.
Alexander Crombie, æt. 19, seaman.
For symptoms see page 159.
Thorax. Mucous membrane of bronchi, in all their ramifications, highly vascular; bronchial tubes full of mucus, mixed with pus. Head. Dura mater adherent with preternatural firmness to cranium; substance of brain unusually firm; posterior lobes crisp, and cut almost like cartilage; anterior lobes, when cut into, abound with bloody points; cerebellum exceedingly firm. Abdomen. Peritoneal coat of small intestines in general vascular; eight or ten portions of the jejunum and ilium, to the extent of three or four inches each, intussuscepted; mucous membrane of these parts extensively ulcerated, some of the ulcers circular, the greater number oblong, and at least two inches in length; mucous membrane in general highly vascular, but that surrounding the ulcers less so than the other parts; mesenteric glands corresponding to ulcerated portions of intestine enlarged and vascular; crimson spots on convex surface of liver; gall-bladder distended with a yellowish watery fluid; spleen enlarged, and so soft as to be easily broken down under the finger.
Case LII.
Thomas Lewis, æt. 51, taylor, admitted on the 8th day of fever. Complaint commenced with general pains, nausea and vomiting, together with cough and dyspnœa. At present there is no pain of chest except on coughing, which produces some uneasiness; cough frequent, with copious sputa; pain of epigastrium; tongue exceedingly parched and dry; much thirst; bowels purged; some pain of head, chiefly in forehead; mind distinct; scarcely any sleep; face pallid; pulse 126, weak. Early next morning died.
Thorax. Mucous membrane of bronchi inflamed; [pleuræ of right lung covered with coagulable lymph; substance of right lung universally consolidated, and infiltrated with tubercular matter;] left lung gorged. Abdomen. [Liver indurated; crisping under the knife; kidneys indurated.] Head. Membranes and substance of brain vascular.
Case LIII.
Mary Sullivan, æt. 40, married, admitted on the 15th day of fever. Some pain of chest; severe cough; much pain of head, with sense of noise; mind dull; scarcely any sleep; face flushed; skin warm; tongue foul and dry; pulse 98.
16th. Frequent short cough, without expectoration; mind confused, yet sensible when spoken to; pulse 90.
17th. Thoracic and cerebral symptoms unchanged; pulse 111, indistinct.
26th. Cough diminished; sensibility increased; she appeared in all respects better until this day, when the cough became more frequent and the expectoration purulent; pulse 60.
27th. Cough frequent; expectoration the same; respiration short and hurried; pulse 60, intermittent.
30th. Respiration became more and more hurried, and the strength rapidly sunk. Died.
Thorax. Mucous membrane of bronchi inflamed; bronchial tubes full of mucus, mixed with pus; [pleuræ adherent; patches of left lung hepatized.] Abdomen. Liver and spleen extremely softened, breaking down under the fingers into a mass like coagulated blood. Head. Membranes and substance of brain pretty healthy.
Case LIV.
Sarah Peach, æt. 23, married, admitted on the 17th day of fever. Thoracic symptoms came on with the very commencement of the disease: at present there is no pain of the chest, but much cough; respiration short and hurried; colour of the face quite dusky; some pain of head; mind confused; pulse 100; abdomen not tender; tongue of beefsteak character; bowels regular.
18th. Cough and hurried respiration continue; dusky colour of face has become livid; delirium; low muttering talkativeness; pulse 116; teeth sordid; stools in bed.
19th. Severity of bronchial symptoms much increased; respiration panting; colour of skin in general, but especially of face, livid; deglutition difficult; pulse 124, weak. Died following morning.
Thorax. Mucous membrane of bronchi inflamed; bronchial tubes filled with mucus, mixed with pus; mucous membrane of trachea vascular; [both lungs studded with miliary tubercles.] Head. Dura mater and arachnoid highly vascular; theca of spinal cord highly vascular; substance of brain vascular. Abdomen. [Spleen contained a small mass of cheesy tubercles near its surface;] patches of mucous membrane of small intestines inflamed, but without ulceration.
Case LV.
Isabella Lora, æt. 12. Admitted on the 3rd day of scarlet fever; throat sore; deglutition painful; slight cough; skin covered with copper-coloured eruption; tongue loaded in middle with white fur; red around edges and at tip; some pain of head; pulse 120.
4th. Much improved; less pain of throat and head; pulse 96.
14th. Convalescent and gradually gaining strength up to this day; early this morning seized suddenly with rigors attended with vomiting: abdomen tender; three stools; pulse scarcely to be felt; mind distinct.
15th. Left parotid painful, hard and swollen; throat again inflamed; pulse 124.
16th. Early this morning seized with symptoms of severe laryngitis, for which leeches have been applied with partial relief; tonsils and uvula much swollen; respiration exceedingly laborious; pulse 140, sharp. Died same day.
Thorax. Tonsils much enlarged; mucous follicles full of purulent fluid mixed with blood; some of them exceedingly enlarged, and communicating so as to form cavities; membrane covering the upper part of larynx highly vascular and much thickened, especially that about the epiglottis and the arytænoid cartilages; mucous membrane below the rima glottidis healthy; both the parotids, the sublingual, and the maxillary glands enlarged. Abdomen. Peritoneal coat of the intestines inflamed and thickened. Head. Membranes and substance of brain tolerably healthy.
Case LVI.
Mary Anne Lawrence, æt. 22, servant, admitted on the 5th day of scarlet fever. Throat sore; deglutition painful; slight uneasiness and sense of tightness in chest; frequent cough, with copious expectoration; abdomen not tender; tongue characteristic; skin warm, covered with scarlet eruption; slight pain of head; pulse 126, strong. V.S. ad ℥xvj.
6th. Felt much relief after venesection; dyspnœa returned in the evening, and she was again bled to the extent of sixteen ounces: blood first drawn with firm buff, that of the second bleeding with coagulum firm but not buffy; at present cough severe, short, dry; dyspnœa; pulse 148.
7th. Tightness of chest continues; cough better; pulse 144, tremulous. Died next day.
Thorax. Uvula and surrounding parts much inflamed, but not ulcerated; mucous membrane of trachea inflamed; bronchial tubes inflamed, and filled with frothy mucus; [pleuræ of both lungs adherent; lungs contained a few tubercles; thyroid gland enlarged, and so hard as to be cut with difficulty.] Abdominal and cerebral organs tolerably healthy.
Case LVII.
Ann Wormington, æt. 24, servant.
After some previous indisposition, seized, the day before admission, with shivering, attended with pain of bowels, nausea and vomiting; throat sore; deglutition painful; scarlet eruption on skin; no uneasiness of chest; no cough; abdomen tender; tongue covered with yellow fur; bowels purged; mind confused; eyes injected and heavy; pulse not to be counted. Died four hours after admission.
Thorax. Mucous membrane of trachea of dark red colour; epiglottis quite blackened; arytænoid cartilages ulcerated; substance of lungs much gorged. Abdomen. Viscera healthy. Head. Membranes vascular; substance of brain preternaturally firm.
Case LVIII.
Margaret Scandling, æt. 26, admitted on the 8th day of fever. No uneasiness of chest; no cough; pain in head; severe pain in limbs and bones; scarcely any sleep; threatening erysipelas on face; abdomen tender; tongue white and dry; no stool for seven days; pulse 88, weak.
10th. No uneasiness of chest; pain of head diminished; pulse 72.
16th. Erysipelas of cheek, spreading to scalp, and attended with considerable pain; tongue dry; pulse 96.
19th. Erysipelas extending; this morning attacked with severe dyspnœa, attended with husky noise in inspiration; deglutition extremely difficult. Hirud. x. gutturi. C.C. ad ℥xij. nuchæ. Capiat Hydrar. Submuriat. gr. ij., c. Pulv. Opii, gr. ss. 6ta q. h.
20th. Respiration and deglutition unrelieved; erysipelas of face very painful; mouth sore; mercurial fetor; pulse 120, soft.
21st. Respiration unchanged; deglutition more painful; erysipelas increased, passing into suppuration; delirium; pulse 90.
22d. Difficulty of deglutition undiminished; respiration rather more easy; pulse 98; much pain of head.
23d. No change in the respiration, deglutition, or erysipelas; much discharge from both ears; left elbow attacked with swelling; heat and excessive pain.
25th. Died.
Thorax. Mucous membrane of larynx inflamed; epiglottis much thickened; both arytænoid cartilages in a state of suppuration, right nearly destroyed; cellular substance about the right parotid in a state of suppuration; [pleuræ of right side adherent; substance of both lungs infiltrated.] Head. Membranes and substance of brain vascular; serum in lateral ventricles. Abdomen. [Mucous membrane of small intestines in several points raised in the form of vesicles, containing air;] spleen soft.
N.B. In this case, the erysipelas evidently extended from the external skin to the mucous membrane of the throat and larynx, an event which is not very common in fever, but which does occasionally happen. The affection of the elbow-joint was clearly of the same nature as that described in case 51.
Case LIX.
Charles Tyler, æt. 54, chocolate maker, admitted on the 7th day of fever. No pain of chest; slight cough; abdomen tender; tongue loaded and dry; thirst; bowels loose; no pain of head; much pain of loins; some vertigo; mind distinct; no sleep; pulse 90, full and firm. V.S. ad ℥xx.
8th. Pain of head and abdomen gone; pulse 102, full and sharp; blood with very firm buff. Repr. V.S. ad ℥xij.
11th. No return of pain in any organ; mind confused; no sleep; great restlessness; delirium; muscular tremor; respiration short and hurried, with mucous rattle; tongue white and dry; pulse too indistinct to be counted.
12th. Delirium became exceedingly violent soon after yesterday’s visit; there was neither pain nor cough, but he passed by the mouth a considerable quantity of fluid blood; respiration became more and more hurried and he died in the evening.
Thorax. Mucous membrane of the trachea and bronchi inflamed; [the substance of the left lung studded with nodules, consisting of coagulated blood, forming the apoplexia pulmonalis of the French writers:] viscera of the head and abdomen healthy.
Case LX.
John Wotton, æt. 46, plaisterer. Admitted on the 7th day of fever: attack commenced with chilliness, succeeded by cough and severe pain in the region of the heart; has had two similar attacks of pain which he soon recovered; at present he has so much pain in the side that he cannot take a full inspiration; frequent cough exciting pain; respiration short and painful; abdomen not tender; tongue white and moist; pain of head; little sleep; pulse 120, full and hard; skin hot.
8th. Pain of chest diminished; can take full inspiration with less uneasiness; cough less frequent; respiration little changed; pulse 102, intermittent.
9th. Respiration much more easy; cough less frequent, with copious mucous expectoration; pulse 108, intermittent.
10th. Says he is quite free from pain everywhere; cough again increased; respirations 50; pulse 110, not intermittent; delirium.
11th. Respirations 60; no sleep; great restlessness; pulse 108, intermittent.
14th. Perfectly insensible; scarcely to be retained in bed; respiration extremely quick; pulse not to be counted. Died.
Thorax. Mucous membrane of bronchi highly vascular; [left lung adherent to parieties of chest by a layer of coagulable lymph nearly an inch in thickness; substance of lung completely hepatized; pericardium exceedingly thickened throughout, and universally adherent to the heart; heart itself soft and flabby; inner coat of aorta of reddish brown colour.] Head. Vessels of pia mater exceedingly turgid; effusion beneath it and the arachnoid; substance of brain very much softened. Abdomen. Mucous membrane of ilium vascular.